Minilaparotomy recommended for most programs: simpler and safer than laparoscopic sterilization.

Minilaparotomy is a simple surgical procedure requiring only basic instruments with no blind insertion of sharp instruments (as with the trocar in laparoscopy) and not requiring insufflation. Instead, a 1-2 inch incision is made just above the pubic hairline, the tubes are located with the aid of a uterine manipulator, and a standard Pomeroy tubal ligation is performed. The abdominal wall is closed in layers. The entire procedure takes 15-30 minutes. Bleeding from the mesosalpinx is less likely because tubal ligation involves less trauma than fulguration or application of a clip or band. In addition, small blood vessels which may be injured are easily clamped or ligated. In those women in which it is not suitable (when the uterus is enlarged, or in fixed retroversion, or when the woman is obsese) a modified procedure involving an incision rather than a trocar puncture of the abdomen is recommended. Because the equipment needs no care beyond sterilization, minilaparotomy is the sterilization procedure of choice for large-scale programs in developing countries.